Provider Demographics
NPI:1407932320
Name:KORNU, CHRISTINE WANG (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:WANG
Last Name:KORNU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:DE-TING
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:24422 AVENIDA DE LA CARLOTA STE 300
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3628
Mailing Address - Country:US
Mailing Address - Phone:949-599-2434
Mailing Address - Fax:949-599-2430
Practice Address - Street 1:4968 BOOTH CIR STE 106
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3370
Practice Address - Country:US
Practice Address - Phone:949-387-4900
Practice Address - Fax:949-387-4945
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77521208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I22998Medicare UPIN
WA77521AMedicare ID - Type Unspecified